Compliance Stuff

The US Departments of Treasury, Labor, and Health and Human Services have issued a sweeping final rule ( CMS -9897-F) implementing significant changes to the Federal Independent Dispute Resolution ( IDR ) process established under the No Surprises Act ( NSA ). This final rule has been long awaited by stakeholders, as changes were proposed by the Departments back in late 2023. It requires health insurers and plans (payers) to provide additional information on initial explanations of benefits (EOBs), reduces administrative fees to $15 per party per dispute, expands batching requirements, and implements substantial procedural reforms to the open negotiation and IDR initiation processes. These changes represent the most comprehensive revisions to the federal IDR process since its inception in 2022. The rule itself will become effective 60 days after it is published in the Federal Register, but some of its provisions will be implemented later. As background, US Congress passed the NSA to ...

On April 27, a jury handed down what is reported to be the first verdict in Massachusetts validating a retaliation claim under the Massachusetts Paid Family and Medical Leave Act (PFMLA). In Boyle v. Wayfair, LLC , the jury found that Wayfair retaliated against plaintiff Mary Boyle for taking PFMLA leave, despite Boyle’s poor — and well-documented — performance reviews that predated her leave. The verdict resulted in a $4.7 million award, including $4 million in punitive damages, $600,000 for emotional distress, and more than $75,000 in back pay, emphasizing the significant risk employers face when terminating employees within six months of their return from PFMLA leave.  The Six-Month Presumption and Its Evidentiary Burden  Typical claims of unlawful retaliation place the initial burden of proof on the employee, but not for adverse actions occurring within the six months following an employee’s return from PFMLA leave. In this window, the Massachusetts legislature codified a...

On April 20, the  US  Supreme Court granted  certiorari  in  Beaird v. United States , No. 25-5343, agreeing to decide whether its 1993 decision in  Stinson v. United States , 508  US  36 (1993), still correctly defines how much deference federal courts owe the official commentary accompanying the  US  Sentencing Guidelines. The outcome could reshape how federal judges calculate sentencing ranges nationwide. The Role of Sentencing Guidelines Commentary After  Stinson v. United States The US Sentencing Commission was created by Congress in 1984 to “ reduce sentencing disparities and promote transparency and proportionality in sentencing .” The Commission issues guidelines in the form of a Guidelines Manual, which reflects the advisory sentencing scheme e stablished by the Supreme Court in  United States v. Booker , 543 US 220 (2005) . In addition to the guidelines themselves, the Guidelines Manual includes policy statements...

In a significant decision, the Delaware Supreme Court reversed the dismissal of Payscale, Inc.’s breach of contract claims arising from Erin Norman’s alleged violations of the noncompete, non-solicitation, and confidentiality provisions contained in the incentive equity agreement that she signed as an employee. The decision reaffirms: (1) nationwide, 18-month noncompetes may be enforceable when they are sufficiently tied to an employer’s articulated economic interests, (2) contingent equity awards are legally sufficient consideration for restrictive covenants , and (3) a plaintiff may plead circumstantial allegations to support claims for breach of non-solicitation and confidentiality provisions. Background Norman entered into an incentive equity agreement that included noncompete, non-solicitation, and confidentiality provisions. In exchange, she received “Profit Interest Units” (PIUs) in Payscale’s parent holding company. At the time, the PIUs were valued at $0, but the PIUs would v...

Certain businesses implement dynamic pricing based on individual preferences or previously collected consumer data. This practice may soon be prohibited in New York if those websites fail to state, “THIS PRICE WAS SET BY AN ALGORITHM USING YOUR PERSONAL DATA.” While currently the subject of litigation, New York’s  Algorithmic Pricing Disclosure Act  seeks to require any entity doing business in New York to provide a clear warning whenever a price is set by an algorithm that uses a consumer’s personal data. The law suggests that it is inadequate for this warning to be included solely in a privacy policy. Instead, it appears that the disclosure must be displayed in the same medium alongside the price. Further, the Act’s definition of personal data is broad, encompassing not only sensitive information but also non-sensitive details that a consumer might provide voluntarily, like zip code and rewards program history . Hence, even if a pricing algorithm uses only non-sensitive per...

For the first time, the A ntitrust Division will offer substantial monetary rewards — between 15% to 30% of any criminal fines recovered — to individuals who provide credible and timely information about illegal activities such as price-fixing, bid-rigging, and market allocation for prosecutions of at least $1 million in fines. Notably, the US Securities and Exchange Commission offers whistleblowers a reward range from 10% to 30%. The DOJ entered a  memorandum of understanding , which outlines the program requirements, with the USPS and United States Postal Service Office of Inspector General (USPS OIG) to form the whistleblower program. Reports can be submitted through a dedicated webpage, and whistleblowers are encouraged to act promptly to help ensure fair competition and accountability. The government stressed that the newly established program is an example of the DOJ’s commitment to root out illicit behavior in all industries, which includes industries where the USPS procur...

Although the law addresses numerous policy areas at the federal level, several of its components specifically address, or will indirectly affect, economic and social dynamics within the District. Below is a detailed discussion of the major elements likely to influence local residents, businesses, and governmental entities, along with the possible implications. One prominent section relevant to the District is the modification of certain individual tax deductions relating to state and local taxes (often referred to as SALT). Under the bill, the limitation on these deductions is extended and further refined, with the changes taking effect for taxable years beginning after December 31. This can significantly affect District taxpayers who typically pay higher local taxes. As the District of Columbia functions both as a city and a quasi-state for many federal legal purposes, these tax changes will alter the after-tax disposable income of residents. This adjustment may influence real estate...

  The government has announced a renewed and expanded focus on False Claims Act ( FCA ) enforcement, doubling down on traditional health care priorities like kickbacks and drug pricing while signaling increased scrutiny of Electronic Health Records ( EHR ) manipulation, a shift that could expose data vendors and other non-traditional health care entities to the  US  Department of Justice ( DOJ ) and the  US  Department of Health and Human Services ( HHS ) scrutiny. Read the announcement  here . Leveraging enhanced cross-agency collaboration and sophisticated data mining, federal agencies are poised to generate new investigative leads, building on recent DOJ enforcement successes. Key Points of Emphasis and Related Compliance Takeaways The revived DOJ-HHS FCA Working Group signals that aggressive, coordinated health care enforcement is not only continuing but expanding into data-driven and technology-enabled frontiers. Reinvigorated False Claims Act Wor...